Appendix D. Change Summary

This Implementation Guide (007030X334) defines the X12 requirements for the Payroll Deducted and Other Group Premium Payment for Insurance Products. It is based on version/release/subrelease 007030 of the ASC X12 standards.

LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionModify Chapter 1
chapter 1, Subsection 1.10.2.2.2 Individual Remittance
Modified figure 1.6 to reflect the new Standard structure
CR 1227The structure of the 820 transaction set was modified in the X12 Standard, modify the implementation guide to reflect the change.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionModify Chapter 1
Modify figure 1.3 to reflect new Standard structure
CR 1227The structure of the 820 transaction set was modified in the X12 Standard, modify the implementation guide to reflect the change.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionAdd Chapter 1
Chapter 1, Subsection 1.10.2.2.2.1 Individual Remittance Advice Detail Relationship to the ASC X12 Benefit Enrollment and Maintenance (834) transaction set
was added to explain the relationship between the 820 and the 834
CR 1225Add information in the front matter of the TR3 describing how the 834 and 820 transactions work together.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionModify Chapter 1
Chapter 1, Subsectio n1.10.2.2.2.1 Individual Remittance Advice Detail Relationship to the ASC X12 Benefit Enrollment and Maintenance (834) transaction set; Paragraph 1
Revised the section to better clarify the relationship
CR 1225Add information in the front matter of the TR3 describing how the 834 and 820 transactions work together.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionModify Chapter 1
Chapter 1, Subsection Reassociation of Dollars and Data: Paragraph 4
Revised and expanded Reassociation of Dollars and Data for clarity
CR 1153Clarify the intended use and instructions for the reassociation of dollars and data.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products
1.10 Data Overview
ActionAdd Chapter 1
Section 1.10.1.1, add the following 3rd paragraph:

One 820 transaction set reflects a single payment device. For example, one 820 transaction corresponds to one check or one EFT payment. Multiple premium amounts can be referenced within a single 820 transaction.
CR 1443Revise the front matter to address reassociation challenges by specifying one 820 corresponds to one EFT or check.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0100
ST - Transaction Set Header
ActionModify Data Element Note
Changed to "The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research."
CR 999Revise the ST02 notes across the TR3's to make them consistent.
LocationX284 | Payroll Deducted and Other Group Premium Payment for Insurance Products
CUR - Foreign Currency Information
ActionDelete Segment
Delete the CUR segment of the header loop
CR 1380This segment is no longer needed to meet the business usage of the 820 transaction.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionAdd Data Element Code Value
BPR01
Added code value 'H' (Notification Only) and note:
Use this code when the actual provider payment (BPR02) is zero and the transaction is not being used for Pre - notification of Future Transfers. This indicates remittance information without any associated payment.
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionDelete Data Element Code Value
Removed code value 'ALC'
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionAdd Data Element Note
Added note to BPR08 "Use this code to identify the type of account in BPR09."
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionAdd Data Element Note
BPR10
Added situational rule: "Required when BPR04 is ACH, BOP or FWT. If not required by this implementation guide, do not send."
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionDelete Data Element Code Value
BPR12
Deleted code value '02' Swift Identification (8 or 11 characters)
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionModify Data Element Situational Rule
BPR05
Changed the Situational Rule to "Required when BPR04 is ACH. If not required by this implementation guide, do not send. "
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionModify Data Element Usage
Changed BPR10 usage from Required to Situational to reflect industry usage.
CR 1229Data element usage change is required to meet industry needs.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionDelete Data Element Code Note
Removed Code Note Value `C' (Credit) on Header BPR, Segment BPR, Element BPR03

Removed:
Use this code to indicate a credit to the payee's account and a debit to the payer's account, initiated by the payer. In the case of an EFT, no additional action is required of the payee. Also use this code when a check is issued for payment.
CR 1515Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionModify Data Element Note
Header/BPR16 (Date)

Changed to "Use when reporting the effective entry date. If BPR04 is ACH, CCC, or DEB, and BPR03 equals "C" this is the date that the money moves from the Payer and is available to the Payee. If BPR04 is ACH, CCC, or DEB, and BPR03 equals "D" this is the earliest date that the Provider can initiate the debit transaction. If BPR04 is CHK, this is the check issuance date. If BPR04 is FWT, this is the date that the Payer anticipates the money to move. As long as the effective date is a business day, this is the settlement date. If BPR04 is NON, enter the creation date for this transaction. If BPR04 is BOP, the financial institution must define the date by mutual agreement with the creator of this transaction."
CR 1265Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0200
BPR - Financial Information
ActionModify Data Element Code Note
Header / BPR06 ((DFI) ID Number Qualifier)

Value 01 (ABA Transit Routing Number Including Check Digits (9 digits))

Changed to:
Use when reporting the ABA transit routing number, which is a unique number identifying every bank in the United States.
CR 1542Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0350
TRN - Reassociation Trace Number
ActionDelete Data Element Code Value
TRN01
Deleted code value '3' Financial Reassociation Identification Number
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0350
TRN - Reassociation Trace Number
ActionAdd Data Element Note
TRN03
Added note: This must be a 1 followed by the payer's EIN (or TIN).
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0350
TRN - Reassociation Trace Number
ActionModify Data Element Usage
Modified TRN03 usage from Situational to Required to align with the 835
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0350
TRN - Reassociation Trace Number
ActionModify Data Element Note
If both TRN04 and BPR11 are used, they must be identical, excluding trailing spaces. Since BPR11 has a min/max value of 9/9, whenever both are used, this element is restricted to a maximum size of 9. If BPR11 is not used, in order to ensure the TRN segment meets the size limitations to be included in the CCD+ addenda record of the EFT transaction, this element is restricted to a maximum size of 20.
CR 1394The TRN04 element note needs to be revised and a clarifying comment providing guidance on when BPR11 is "used" or "not used" in conjunction with TRN04 is needed.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0600
DTM - Process Date
ActionModify Segment Usage
Modified the DTM (Process Date) usage from Situational to Required to reflect industry needs.
CR 1229Data element usage change is required to meet industry needs.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0600
DTM - Delivery Date
ActionModify Segment Usage
Modified the DTM (Delivery Date) usage from Situational to Required to reflect industry needs.
CR 1229Data element usage change is required to meet industry needs.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0600
DTM - Coverage Period
ActionModify Segment Usage
Header Coverage Period DTM segment:
Modified the DTM (Coverage Period) usage from Situational .
CR 1229Data element usage change is required to meet industry needs.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0600
DTM - Creation Date
ActionModify Segment Usage
Header Creation Date DTM segment: Modified the DTM (Creation Date) usage from Situational to Required
CR 1229Data element usage change is required to meet industry needs.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionAdd Segment Note
Loop 1000A Premium Receiver's Name N1 Segment Added the following TR3 note: Use this N1 loop to provide the name/address information of the
payee. The identifying reference number is provided in N104.
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionModify Data Element Usage
Modified the usage of NM102 from Situational to Required to align with the 835
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionModify Data Element Situational Rule
Loop ID 1000C (Intermediary Bank Information) Data Element N102 (Name) Situational Rule:

Changed to "Required when a value is not being sent in N104. If not required by this implementation guide, do not send."
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionModify Data Element Usage
Loop ID 1000A (Premium Receiver's Name), Segment N1, Data Element N102 (Premium Receiver's Name) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionModify Data Element Usage
Loop ID 1000A, (Premium Receiver's Name), Segment N1, Data Element N103 (Identification Code Qualifier) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionAdd Data Element Situational Rule
New situational rule on Loop ID 1000A (Premium Receiver's Name) Segment N1, Data Element N103 (Identification Code Qualifier)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionModify Data Element Usage
Update Loop ID 1000A (Premium Receiver's Name), Segment N1, Data Element N104 (Premium Receiver's Identification Code) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000A
N1 - Premium Receiver's Name
ActionAdd Segment Situational Rule
Add situational rule (shared note 12135) on Loop ID 1000A (Premium Receiver's Name), Segment N1, Data Element N104 (Premium Receiver's Identification Code)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0900 | 1000A
N3 - Premium Receiver's Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1000 | 1000A
N4 - Premium Receiver's City, State, and ZIP Code
ActionModify Data Element Usage
Modify the N402 element usage from Situational to Required to align with the 835
CR 1228The 835 and 820 should be consistent when appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1000 | 1000A
N4 - Premium Receiver's City, State, and ZIP Code
ActionModify Segment Usage
Update Loop ID 1000A, Segment N4 (Premium Receiver's City, State, and Zip Code) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1000 | 1000A
N4 - Premium Receiver's City, State, and ZIP Code
ActionAdd Segment Situational Rule
Add situational rule (shared note 12626) on Loop ID 1000A, Segment N3 (Premium Receiver's City, State, and Zip Code)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionAdd Data Element Usage
Update Loop ID 1000B (Premium Payer's Name), Segment N1, Data Element N102 (Name) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionAdd Data Element Situational Rule
New situational rule on Loop ID 1000B (Premium Payer's Name), Segment N1, Data Element N102 (Name)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionModify Data Element Usage
Update Loop ID 1000B (Premium Receiver's Name), Segment N1, Data Element N103 (Identification Code Qualifier) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionAdd Data Element Situational Rule
Add new situational rule on Loop ID 1000B Segment N1, Data Element N103 (Identification Code Qualifier)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionModify Data Element Usage
Update Loop ID 1000B, Segment N104 (Premium Payer Identification Code) usage from REQUIRED to SITUATIONAL
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000B
N1 - Premium Payer's Name
ActionAdd Data Element Situational Rule
Add situational rule (shared note 12135) on Loop ID 1000A Segment N1, Data Element N104 (Premium Payer Identification Code)
CR 1477Re-evaluate usage requirements in the 1000A and 1000B loops of the 820 TR3. This may be a situation when the 820 requirements should not align with the corresponding 835 requirements.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1200 | 1000B
PER - Premium Payer's Administrative Contact Information
ActionModify Data Element Code Note
Multiple Loops / PER05 and PER07

EX (Extension)

Changed to:
Use when reporting a telephone extension for the preceding telephone number.
CR 1542Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000C
N1 - Intermediary Bank Information
ActionModify Data Element Situational Rule
Loop ID 1000C (Intermediary Bank Information) Data Element N102 (Name) Situational Rule:

Changed to "Required when a value is not being sent in N104. If not required by this implementation guide, do not send."
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0700 | 1000C
N1 - Intermediary Bank Information
ActionModify Data Element Situational Rule
Loop ID 1000C/N103 Identification Code Qualifier

Changed to "Required when N104 is used. If not required by this implementation guide, do not send."
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1200 | 1000C
PER - Intermediary Bank's Administrative Contact Information
ActionModify Data Element Code Note
Multiple Loops / PER05 and PER07

EX (Extension)

Changed to:
Use when reporting a telephone extension for the preceding telephone number.
CR 1542Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0800 | 2200A
ADX - Organization Summary Remittance Level Adjustment for Previous Payment
ActionModify Data Element Usage
Loop 2200A, ADx segment (Organization Summary Remittance Level Adjustment for Changed ADX03 from Not Used to Situational and added Situational Rule: Required when an identifier is sent in ADX04. If not required by this Implementation Guide, do not send.
CR 489Revise to allow for an identification number that further links to an adjustment from a prior month.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0800 | 2200A
ADX - Organization Summary Remittance Level Adjustment for Previous Payment
ActionModify Data Element Usage
Changed ADX04 from Not Used to Situational
CR 489Revise to allow for an identification number that further links to an adjustment from a prior month.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0800 | 2200A
ADX - Organization Summary Remittance Level Adjustment for Previous Payment
ActionAdd Data Element Code Value
Code value '1X' added to ADX03
CR 489Revise to allow for an identification number that further links to an adjustment from a prior month.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0800 | 2200A
ADX - Organization Summary Remittance Level Adjustment for Previous Payment
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1500 | 2300A
RMR - Organization Summary Remittance Detail
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1800 | 2300A
DTM - Organizational Coverage Period
ActionModify Segment Usage
Modify Loop ID 2300A (Organization Summary Remittance Detail), DTM Segment (Organizational Coverage Period) TR3 Usage as follows [B1]:

From: Situational

To: Required
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1800 | 2300A
DTM - Organizational Coverage Period
ActionDelete Segment Situational Rule
Delete Loop ID 2300A (Organization Summary Remittance Detail), DTM Segment (Organizational Coverage Period) Situational Rule (Shared Note 12138) as follows

Remove:
Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 1800 | 2300A
DTM - Organizational Coverage Period
ActionDelete Segment Situational Rule
Delete Loop ID 2210B (Individual Premium Remittance Detail), DTM Segment (Individual Coverage Period) Situational Rule (Shared Note 12138)

Remove:
Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 2100 | 2320A
ADX - Organization Summary Remittance Level Adjustment for Current Payment
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5600 | 2000B
INS - Member Level Detail
ActionModify Loop
Removed ENT from 2000B loop. Added 3 REF segments and 1 DTP segment.
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5600 | 2000B
INS - Member Level Detail
ActionModify Data Element Code Note
on INS02 code 23 (Sponsored Dependent):
From
Dependents age 19 and older; qualifications may vary depending on policy.

To
Use when the dependent is age 26 or older; qualifications may vary depending on policy.
CR 1396Revise the code value notes for consistency.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5600 | 2000B
INS - Member Level Detail
ActionModify Data Element Situational Rule
on INS12:
From
Required if the subscriber/dependent is deceased. If not required by this implementation guide, do not send. This is the date of death for the subscriber/dependent and does not replace the use of the termination date within the 2300 loop.

To
Required when the Insured is known to be deceased. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionModify Data Element Usage
Changed from Not Used to Situational.
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionModify Data Element Usage
Changed from Not Used to Situational.
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionAdd Data Element Situational Rule
Loop ID 2000B/NM108

Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionAdd Data Element Code Value
Loop ID 2000B/NM108

TI Individual Taxpayer Identification Number (ITIN)
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionAdd Data Element Situational Rule
Loop ID 2000B/NM109

Required when the information in this segment is being sent as a result of a premium payment and is needed to match the 834 enrollment information to the premium payment information, or when required by trading partner agreement. If not required by this implementation guide, do not send.
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5620 | 2000B
NM1 - Member Name
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5640 | 2000B
REF - Subscriber Identifier
ActionModify Segment
Moved NM1 segment from 2000B to 2100B
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5640 | 2000B
REF - Member Policy Number
ActionDelete Data Element Code Note
Remove Code Note Value `1L' (Group or Policy Number) on Loop 2000B, Segment REF (Subscriber Identifier), Element REF01

Remove:
The payer is responsible for making the assignment of the Group or Policy Number.
CR 1515Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5700 | 2100B
ADX - Individual Premium Adjustment for Previous Payment
ActionModify Data Element Usage
Changed ADX03 from Not Used to Situational, added situational rule amd code value '1X'
CR 489Revise to allow for an identification number that further links to an adjustment from a prior month.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5700 | 2100B
ADX - Individual Premium Adjustment for Previous Payment
ActionModify Data Element Usage
Changed ADX04 from Not Used to Situational
CR 489Revise to allow for an identification number that further links to an adjustment from a prior month.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5700 | 2100B
ADX - Individual Premium Adjustment for Previous Payment
ActionModify Loop
Deleted the NM1 segment and added the ADX segment to loop 2100B
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5700 | 2100B
ADX - Individual Premium Adjustment for Previous Payment
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5800 | 2200B
HD - Health Coverage
ActionModify Loop
Deleted ADX segment and added HD,DTP and REF segments to 2200D loop
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5800 | 2200B
HD - Health Coverage
ActionAdd Data Element Code Value
CDV (Combined Dental and Vision) to HD03 (Insurance Line Code).
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5800 | 2200B
HD - Health Coverage
ActionAdd Data Element Code Value
COM (Combined insurance lines other than dental and vision) to HD03 (Insurance Line Code).
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5800 | 2200B
HD - Health Coverage
ActionAdd Data Element Code Note
HD03 Code Value COM (Combined insurance lines other than dental and vision)

Use when identifying combined insurance lines other than dental and vision that are not QHP Products under Exchange business.
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5850 | 2200B
DTP - Health Coverage Dates
ActionModify Segment Situational Rule
Change the Situational Rule at Loop ID 2200B (Health Coverage), DTP Segment (Health Coverage Dates)


To (Unique Note Number 351752):

Required when the information in this segment is being sent as a result of a premium payment and is needed to match the 834 enrollment information to the premium payment information, or when required by trading partner agreement. If not required by this implementation guide, do not send.
CR 1606Review to ensure situational rules are shared, consistent, or similar, as appropriate.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5850 | 2200B
DTP - Health Coverage Dates
ActionModify Data Element Code Note
on DTP01 code 695 (Previous Period):
From
This value is only to be used when reporting Previous Coverage Months.

To
Use when DTP01 is equal to 695 - Previous Period.
CR 1396Revise the code value notes for consistency.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5900 | 2210B
RMR - Individual Premium Remittance Detail
ActionAdd Loop
Added loop 2210B with segments RMR, REF, and DTM
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5900 | 2210B
RMR - Individual Premium Remittance Detail
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5970 | 2210B
DTM - Individual Coverage Period
ActionDelete Segment Situational Rule
Delete Loop ID 2300A (Organization Summary Remittance Detail), DTM Segment (Organizational Coverage Period) Situational Rule (Shared Note 12138) as follows

Remove:
Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5970 | 2210B
DTM - Individual Coverage Period
ActionModify Segment Usage
Modify Loop ID 2210B (Individual Premium Remittance Detail), DTM Segment (Individual Coverage Period) TR3 Usage


From: Situational

To: Required
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5970 | 2210B
DTM - Individual Coverage Period
ActionDelete Segment Situational Rule
Delete Loop ID 2210B (Individual Premium Remittance Detail), DTM Segment (Individual Coverage Period) Situational Rule (Shared Note 12138)

Remove:
Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
CR 1605The 820 receiver needs the start and end date of the organizational coverage period.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5980 | 2215B
ADX - Individual Premium Adjustment for Current Payment
ActionAdd Loop
Added loop 2215B with segment ADX
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5980 | 2215B
ADX - Individual Premium Adjustment for Current Payment
ActionModify Data Element Code Note
Replace Shared Code Note for Value `AX' (Person No Longer Employed) on Loop 2215B, Segment ADX, Element ADX-02


Use when a person is no longer employed. This is not a substitute for an 834 termination notice. This code (AX) is used at the organization level and individual level. The note refers to a "person" and should be applicable at the individual level only.
CR 1515Improve the consistency of the code value notes within and across the TR3s.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 5980 | 2215B
ADX - Individual Premium Adjustment for Current Payment
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 6000 | 2300B
N1 - Reporting Category
ActionModify Loop
Deleted RMR, REF and DTM segments from 2300B loop and added N1, REF and new DTM segments to the 2300B loop.
CR 1330Member detail information should be consistent between the 834 and 820 transactions.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 6070 | 2300B
DTM - Reporting Category Date
ActionModify Segment Situational Rule
Loop ID 2300B/DTM Segment

Changed to "Required when specifying the reference identifier associated with the reporting category. If not required by this implementation guide, do not send"
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX334 | Payroll Deducted and Other Group Premium Payment for Insurance Products | 820 | 0100
SE - Transaction Set Trailer
ActionAdd Data Element Note
Transaction Set Trailer/SE02 Transaction Set Control Number

The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research.
CR 999Revise the ST02 notes across the TR3's to make them consistent.